Good Management is Most Welcome, Of Course the Medicaid Program Should Require Pre-Authorizations
Posted on: Tuesday, 30 August 2005, 00:00 CDT
TO fund the Medicaid program, state officials have tried all sorts of gimmicks. The provider tax slapped on hospitals and doctors was in fact a tax on the sick.
Now state officials are trying something new - managing the program better.
Nationally, there is a movement to increase co-payments a little. This would discourage overuse of the program.
Now, West Virginia officials want to require prior approval before doctors perform outpatient surgery and other procedures, said Shelley Baston, director of the Bureau for Medical Service's Office of Healthcare Policy and Management Care Coordination.
"Requiring prior authorization on these services is standard practice of insurance companies," Baston told an Associated Press reporter. "Medicaid just has never done it before."
The pre-authorizations are part of a plan to cut expenses by $115.7 million. Considering that the program faces a $156 million deficit, changes are due.
Medicaid in West Virginia covers 373,000 people who are needy; aged, blind or disabled residents; and low-income families with children. The state's program costs $2.1 billion annually, with the federal government picking up nearly three-quarters of the bill.
Not surprisingly, health care providers are not thrilled with the changes. Mike Robbins, the West Virginia Hospital Association's vice president for financial policy, said this will change how business is done.
"I'm not saying it's not appropriate," Robbins told the AP's Michelle Saxon. "There are just additional layers of bureaucracy and time involved in that process that may make it harder for a patient to access those services."
That complaint will not impress people who pay far more for coverage by virtually all other health care plans. Any insurance organization that covers 373,000 people in West Virginia should require pre-authorization.
That is basically what Medicaid is, but instead of charging the clients premiums, the insurer takes that money from everyone else.
The public understands the mission of Medicaid.
What people cannot understand is why it should not be run the same way any other insurance program would.
Source: Charleston Daily Mail
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